Predicting neurodevelopmental outcomes in Australian First Nations infants: The transdiagnostic utility of early screening tools

Aim To determine the predictive relationship between evidence‐based screening tools and neurodevelopmental outcomes in Australian First Nations infants. Method This prospective cohort study invited First Nations families to participate in a culturally adapted early developmental screening programme. A total of 156 infants (55.1% male, mean gestational age = 33.6 weeks, SD = 4.6) were screened using the Prechtl's General Movements Assessment, with optimality scoring using the Motor Optimality Score‐Revised (MOS‐R) at 3 to 5 months and the Hammersmith Infant Neurological Examination (HINE) at 4 to 9 months. Participants completed ‘baby movement (BM) checks’ at two time points (BM1, 3–5 months corrected age; BM2, 4–9 months corrected age), with final movement and learning checks at 12 months corrected age. At 12 months corrected age, standardized motor, cognitive, and communication assessments, neurodisability‐specific symptomology, or a diagnosis made by a paediatrician classified infants as developing typically (‘on track’) or (1) with a high chance of or confirmed cerebral palsy (CP) or (2) non‐CP neurodevelopmental delay (NDD), including autism and fetal alcohol spectrum disorder (FASD). Predictive relationships were investigated using logistic regression and diagnostic statistics. Results At 12 months, 127 of 147 (86%) eligible infants ( n = 9 withdrawn or deceased) were classified as ‘on track’ ( n = 55, 43%), NDD ( n = 59, 47%), or CP ( n = 13, 10%). MOS‐R (≥ 14 weeks). The HINE distinguished infants as ‘on track’, CP, or NDD. Each 1‐point decrease on both tools increased the odds of NDD (OR MOS‐R = 1.40, 95% confidence interval [CI] = 1.00–1.96; OR HINE = 1.12, 95% CI = 1.05–1.21) and CP (OR MOS‐R = 1.47, 95% CI = 1.08–2.01; OR HINE = 1.41, 95% CI = 1.21–1.65,). The MOS‐R (cut‐off of less than 23) and HINE (moderate to severely reduced) were best for identifying any NDD and CP (MOS‐R: sensitivity = 84%, specificity = 38%; HINE: sensitivity = 64%, specificity = 63%). Combined trajectories across both tools were the strongest predictors of CP (sensitivity = 73%, specificity = 96%), autism (sensitivity = 59%, specificity = 95%), and FASD (sensitivity = 89%, specificity = 93%). Interpretation Evidence‐based screening tools demonstrate promising transdiagnostic prediction of ‘on‐track’ development and not only high chance of CP but also autism, FASD, and other NDDs.